MEDICARE: DR. GORDON LUCAS FIFER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	35.151509	OH
2	208800000X	Urology Physician	ME156455	FL

General Provider Information

NPI Number	:	1497729933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON LUCAS FIFER MD

Provider Business Mailing Address
First Line	:	12109 COUNTY ROAD 103
Second Line	:
City	:	OXFORD
State	:	FL
Zip	:	34484-2951
Country	:	US
Telephone Number	:	352-205-8981
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5137
Country	:	US
Telephone Number	:	904-824-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	10/29/2024

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